Treatment Estimate

An all-purpose treatment conference tool

This form may be used for all types of treatment conferences. It documents exact financial arrangements and co-payments for your patient and supplements the informed consent process. (Click on Informed Consent Forms on products page). Use this form to eliminate disputes over finances and treatment.

• Financial arrangements to fit any office
• Service Charge - implement if applicable
• Dental Insurance - patient responsibility
• Informed Consent
• Most common dental treatment procedures listed on one easy - to - use form

To preview
Sample Form in PDF format

CLICK HERE

Privacy Policy

Stepping Stones to Success is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 8/1/2009 to 7/31/2012.